Basic Information
| Provider Information | |||||||||
| NPI: | 1477611176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDOWELL | ||||||||
| FirstName: | LAVETA | ||||||||
| MiddleName: | LARRAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7142 SAN PEDRO AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106615622 | ||||||||
| FaxNumber: | 2103954012 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 SIDNEY BAKER ST S | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | KERRVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780285994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308967607 | ||||||||
| FaxNumber: | 8308968482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | K5619 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 310440YS6N | 01 | TX | MEDICARE PTAN | OTHER | 325752901 | 05 | TX | MEDICAID |